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  • 1
    Online Resource
    Online Resource
    Optimizing Order of Administration for Concussion Baseline Assessment Among NCAA Student-Athletes and Military Cadets
    Springer Science and Business Media LLC ; 2022
    In:  Sports Medicine Vol. 52, No. 1 ( 2022-01), p. 165-176
    Details
    In: Sports Medicine, Springer Science and Business Media LLC, Vol. 52, No. 1 ( 2022-01), p. 165-176
    Type of Medium: Online Resource
    ISSN: 0112-1642 , 1179-2035
    URL: Article
    DOI: 10.1007/s40279-021-01493-y
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2025521-4
    SSG: 31
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  • 2
    Online Resource
    Online Resource
    Vision Diagnoses Are Common After Concussion in Adolescents
    SAGE Publications ; 2016
    In:  Clinical Pediatrics Vol. 55, No. 3 ( 2016-03), p. 260-267
    Details
    In: Clinical Pediatrics, SAGE Publications, Vol. 55, No. 3 ( 2016-03), p. 260-267
    Abstract: Objective. To determine the prevalence of vision diagnoses after concussion in adolescents. Methods. Cross-sectional study from July 1, 2013 to February 28, 2014, of patients aged 11 to 17 years with concussion evaluated in a comprehensive concussion program. Results. A total of 100 adolescents were examined, with a mean age of 14.5 years. Overall, 69% had one or more of the following vision diagnoses: accommodative disorders (51%), convergence insufficiency (49%), and saccadic dysfunction (29%). In all, 46% of patients had more than one vision diagnosis. Conclusions. A high prevalence of vision diagnoses (accommodative, binocular convergence, and saccadic eye movement disorders) was found in this sample of adolescents with concussion, with some manifesting more than one vision diagnosis. These data indicate that a comprehensive visual examination may be helpful in the evaluation of a subset of adolescents with concussion. Academic accommodations for students with concussion returning to the classroom setting should account for these vision diagnoses.
    Type of Medium: Online Resource
    ISSN: 0009-9228 , 1938-2707
    URL: Article
    DOI: 10.1177/0009922815594367
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2066146-0
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  • 3
    Online Resource
    Online Resource
    Sport Specialization and Exposure in a Tertiary Concussion Program
    American Academy of Pediatrics (AAP) ; 2021
    In:  Pediatrics Vol. 147, No. 3_MeetingAbstract ( 2021-03-01), p. 169-170
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 147, No. 3_MeetingAbstract ( 2021-03-01), p. 169-170
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.147.3MA2.169
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2021
    detail.hit.zdb_id: 1477004-0
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  • 4
    Online Resource
    Online Resource
    Sport Specialization and Exposure in a Tertiary Concussion Program
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0053-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0053-
    Abstract: Sport specialization is an important area of focus within pediatric sports medicine with studies relating specialization to the rising incidence of sport-related injuries. The relationship between sport specialization and concussion remains unexplored. Hypothesis/Purpose: The objective of this study was to assess the prevalence of sport specialization and its relationship to concussion in athletes seen in a tertiary concussion program. Methods: Athletes completed a sport specialization questionnaire as part of a comprehensive intake questionnaire and were classified into low, moderate, or high specialization groups using a previously published 3-point scale. Categories were derived from their responses to 3 binary questions: 1) Have you quit other sports to focus on 1 sport? 2) Do you train 〉 8 months out of the year in 1 sport? 3) Do you consider your primary sport more important than other sports? Results: Of the 1,098 athletes, ages 8-19 years, who completed the questionnaire, 572 (52%) were female, 718 (65.5%) had a sports-related concussion (SRC) and 439 (40%) had a prior history of concussion. The cohort was categorized into low (n=568, 51.7%), moderate (n=339, 30.9%), or high (n=191, 17.4%) sport specialization groups. Athletes reported their primary sport was more important than other sports (702, 64%) and training 〉 8 months out of the year in 1 sport (594, 54%) more commonly than quitting other sports to focus on 1 sport (270, 25%). Sport specialization differed by primary sport (Figure 1), but did not significantly differ when primary sport was grouped by level of contact (p=0.47). Sport specialization did not significantly differ by sex, race, or ethnicity, but significantly differed by insurance (p=0.014) and age (p=0.0001), with greater specialization among those with private insurance and adolescents, respectively. Moderately or highly specialized athletes were significantly more likely than less specialized athletes to present with a SRC compared to a non-SRC (p 〈 0.0001) and to report prior history of concussion (p=0.005). After controlling for demographic and sport participation factors, only endorsement of training more than 8 months out of the year in one sport was significantly associated with SRC (p=0.001) and prior concussion (p=0.007). Conclusion: Sport specialization is prevalent among youth athletes with concussion. Training 〉 8 months out of the year in a single sport is associated with SRC and prior history of concussion. Further research is warranted to evaluate how exposure among specialized athletes relates to concussion.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00537
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 5
    Online Resource
    Online Resource
    Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Clinical Journal of Sport Medicine Vol. 28, No. 2 ( 2018-03), p. 139-145
    Details
    In: Clinical Journal of Sport Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 2 ( 2018-03), p. 139-145
    Abstract: Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children. Design: A retrospective cohort of pediatric patients with concussion. Setting: A subspecialty pediatric concussion program. Patients (or Participants): Four hundred thirty-two patient records were abstracted. Assessment of Risk Factors: Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program. Main Outcome Measures: The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels. Results: Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time. Conclusions: Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.
    Type of Medium: Online Resource
    ISSN: 1050-642X
    URL: Article
    DOI: 10.1097/JSM.0000000000000507
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2045233-0
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  • 6
    Online Resource
    Online Resource
    Near Point of Convergence after Concussion in Children
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Optometry and Vision Science Vol. 94, No. 1 ( 2017-1), p. 96-100
    Details
    In: Optometry and Vision Science, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 1 ( 2017-1), p. 96-100
    Abstract: To determine the incidence of abnormal near point of convergence (NPC) after acute concussion in pediatric patients and to describe the clinical course of such patients. Methods A retrospective cohort study of 275 pediatric patients 5 to 18 years of age presenting to a tertiary care children’s hospital subspecialty concussion program with a new concussion between July 1, 2014 and June 30, 2015 was conducted. Results Sixty-seven out of 275 pediatric patients presenting to a subspecialty concussion referral program were found to have abnormal NPC on physical examination as measured by an accommodative rule. Twenty-six (46%) patients recovered with standard clinical care over a median time frame of 4.5 weeks (range 1–18), including a brief period of cognitive and physical rest followed by gradual return to school and physical activities without any formal interventions. An additional 23 (41%) patients recovered a median of 11 weeks post-injury after referral for formal vestibular therapy, including interventions for abnormal convergence, such as Brock string and pencil pushups. Seven (13%) patients with persistent abnormal NPC and concomitant symptoms that necessitated referral for formal office-based vision therapy with developmental optometry recovered a median of 23 weeks post-injury and a median of 16 weeks after referral to vision therapy. Conclusions Assessment for NPC is a diagnostic entity that warrants consideration in children with concussion. Concussion questionnaires may not be sensitive to detect vision symptoms in children, making an accurate assessment for convergence important in the evaluation of concussion. Some children with abnormal NPC will recover without any formal intervention after concussion; however, a subset of patients with persistent abnormal NPC after concussion may benefit from interventions including vestibular and/or vision therapy.
    Type of Medium: Online Resource
    ISSN: 1538-9235 , 1040-5488
    URL: Article
    DOI: 10.1097/OPX.0000000000000910
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2083924-8
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  • 7
    Online Resource
    Online Resource
    Estimating the Relationship Between the Symptom-Free Waiting Period and Injury Rates After Return-to-Play from Concussion: A Simulation Analysis Using CARE Consortium Data
    Springer Science and Business Media LLC ; 2023
    In:  Sports Medicine
    Details
    In: Sports Medicine, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 0112-1642 , 1179-2035
    URL: Article
    DOI: 10.1007/s40279-023-01901-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2025521-4
    SSG: 31
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  • 8
    Online Resource
    Online Resource
    Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance
    SAGE Publications ; 2018
    In:  The American Journal of Sports Medicine Vol. 46, No. 7 ( 2018-06), p. 1742-1751
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 46, No. 7 ( 2018-06), p. 1742-1751
    Abstract: A student-athlete’s mental state, including history of trait anxiety and depression, or current psychological state may affect baseline concussion assessment performance. Purpose: (1) To determine if mental illness (anxiety, depression, anxiety with depression) influences baseline scores, (2) to determine if psychological state correlates with baseline performance, and (3) to determine if history of concussion affects Brief Symptom Inventory–18 (BSI-18) subscores of state anxiety, depression, and somatization. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A sample of 8652 collegiate student-athletes (54.5% males, 45.5% females) participated in the Concussion Assessment, Research and Education (CARE) Consortium. Baseline assessments included a demographic form, a symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, a psychological state assessment (BSI-18), and Immediate Post-concussion Assessment and Cognitive Test. Baseline scores were compared between individuals with a history of anxiety (n = 59), depression (n = 283), and anxiety with depression (n = 68) and individuals without a history of those conditions (n = 8242). Spearman’s rho correlations were conducted to assess the relationship between baseline and psychological state subscores (anxiety, depression, somatization) (α = .05). Psychological state subscores were compared between individuals with a self-reported history of concussions (0, 1, 2, 3, 4+) using Kruskal-Wallis tests (α = .05). Results: Student-athletes with anxiety, depression, and anxiety with depression demonstrated higher scores in number of symptoms reported (anxiety, 4.3 ± 4.2; depression, 5.2 ± 4.8; anxiety with depression, 5.4 ± 3.9; no anxiety/depression, 2.5 ± 3.4), symptom severity (anxiety, 8.1 ± 9.8; depression, 10.4 ± 12.4; anxiety with depression, 12.4 ± 10.7; no anxiety/depression, 4.1 ± 6.9), and psychological distress in state anxiety (anxiety, 3.7 ± 4.7; depression, 2.5 ± 3.6; anxiety with depression, 3.8 ± 4.2; no anxiety/depression, 0.8 ± 1.8), depression (anxiety, 2.4 ± 4.0; depression, 3.2 ± 4.5; anxiety with depression, 3.8 ± 4.8; no anxiety/depression, 0.8 ± 1.8), and somatization (anxiety, 2.3 ± 2.9; depression, 1.8 ± 2.8; anxiety with depression, 2.2 ± 2.4; no anxiety/depression, 0.9 ± 1.7). A moderate positive relationship existed between all BSI-18 subscores and total symptom number (n = 8377; anxiety: r s = 0.43, P 〈 .001; depression: r s = 0.42, P 〈 .001; somatization: r s = 0.45, P 〈 .001), as well as total symptom severity (anxiety: r s = 0.43, P 〈 .001; depression: r s = 0.41, P 〈 .001; somatization: r s = 0.45, P 〈 .001). Anxiety, depression, and somatization subscores were greater among student-athletes that self-reported more concussions. Conclusion: Clinicians should be cognizant that student-athletes with a history of trait anxiety, depression, and anxiety with depression may report higher symptom score and severity at baseline. Individuals with extensive concussion history may experience greater state anxiety, depression, and somatization.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546518765145
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 9
    Online Resource
    Online Resource
    Investigating the Range of Symptom Endorsement at Initiation of a Graduated Return-to-Play Protocol After Concussion and Duration of the Protocol: A Study From the National Collegiate Athletic Association–Department of Defense Concussion, Assessment, Research, and Education (CARE) Consortium
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 6 ( 2020-05), p. 1476-1484
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 6 ( 2020-05), p. 1476-1484
    Abstract: Organizations recommend that athletes should be asymptomatic or symptom-limited before initiating a graduated return-to-play (GRTP) protocol after sports-related concussion, although asymptomatic or symptom-limited is not well-defined. Hypotheses: (1) There will be a range (ie, beyond zero as indicator of “symptom-free”) in symptom severity endorsement when athletes are deemed ready to initiate a GRTP protocol. (2) Baseline symptom severity scores and demographic/preinjury medical history factors influence symptom severity scores at the commencement of the GRTP protocol. (3) Greater symptom severity scores at GRTP protocol initiation will result in longer protocol duration. (4) Symptom severity scores will not differ between those who did and did not sustain a repeat injury within 90 days of their initial injury. Study Design: Cohort study; Level of evidence, 2. Methods: Across 30 universities, athletes (N = 1531) completed assessments at baseline and before beginning the GRTP protocol, as determined by local medical staff. Symptom severity scores were recorded with the symptom checklist of the Sport Concussion Assessment Tool–3rd Edition. Nonparametric comparisons were used to examine the effect of medical, demographic, and injury factors on symptom endorsement at GRTP protocol initiation, as well as differences in symptom severity scores between those who did and did not sustain a repeat injury within 90 days. A Cox regression was used to examine the association between symptom severity scores at GRTP protocol initiation and protocol duration. Results: Symptom severity scores at the time when the GRTP protocol was initiated were as follows: 0 to 5 (n = 1378; 90.0%), 6 to 10 (n = 76; 5.0%), 11 to 20 (n = 42; 3.0%), and ≥21 (n = 35; 2.0%). Demographic (sex and age), medical (psychiatric disorders, attention-deficit/hyperactivity disorder, learning disorder), and other factors (baseline symptom endorsement and sleep) were significantly associated with higher symptom severity scores at the GRTP initiation ( P 〈 .05). The 4 GRTP initiation time point symptom severity score groups did not significantly differ in total time to unrestricted RTP, χ 2 (3) = 1.4; P = .73. When days until the initiation of the GRTP protocol was included as a covariate, symptom severity scores between 11 and 20 ( P = .02; hazard ratio = 1.44; 95% CI, 1.06-1.96) and ≥21 ( P 〈 .001; hazard ratio = 1.88; 95% CI, 1.34-2.63) were significantly associated with a longer GRTP protocol duration as compared with symptom severity scores between 0 and 5. Symptom severity scores at GRTP initiation did not significantly differ between those who sustained a repeat injury within 90 days and those who did not ( U = 29,893.5; P = .75). Conclusion: A range of symptom severity endorsement was observed at GRTP protocol initiation, with higher endorsement among those with higher baseline symptom endorsement and select demographic and medical history factors. Findings suggest that initiation of a GRTP protocol before an absolute absence of all symptoms is not associated with longer progression of the GRTP protocol, although symptom severity scores 〉 10 were associated with longer duration of a GRTP protocol. Results can be utilized to guide clinicians toward optimal GRTP initiation (ie, balancing active recovery with avoidance of premature return to activity).
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520913252
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 10
    Online Resource
    Online Resource
    Estimated age of first exposure to American football and outcome from concussion
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Neurology Vol. 95, No. 21 ( 2020-11-24), p. e2935-e2944
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 95, No. 21 ( 2020-11-24), p. e2935-e2944
    Abstract: To examine the association between estimated age at first exposure (eAFE) to American football and clinical measures throughout recovery following concussion. Methods Participants were recruited across 30 colleges and universities as part of the National Collegiate Athletic Association (NCAA)–Department of Defense Concussion Assessment, Research and Education Consortium. There were 294 NCAA American football players (age 19 ± 1 years) evaluated 24–48 hours following concussion with valid baseline data and 327 (age 19 ± 1 years) evaluated at the time they were asymptomatic with valid baseline data. Participants sustained a medically diagnosed concussion between baseline testing and postconcussion assessments. Outcome measures included the number of days until asymptomatic, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) composite scores, Balance Error Scoring System (BESS) total score, and Brief Symptom Inventory 18 (BSI-18) subscores. The eAFE was defined as participant's age at the time of assessment minus self-reported number of years playing football. Results In unadjusted regression models, younger eAFE was associated with lower (worse) ImPACT Visual Motor Speed ( R 2 = 0.031, p = 0.012) at 24–48 hours following injury and lower (better) BSI-18 Somatization subscores ( R 2 = 0.014, p = 0.038) when the athletes were asymptomatic. The effect sizes were very small. The eAFE was not associated with the number of days until asymptomatic, other ImPACT composite scores, BESS total score, or other BSI-18 subscores. Conclusion Earlier eAFE to American football was not associated with longer symptom recovery, worse balance, worse cognitive performance, or greater psychological distress following concussion. In these NCAA football players, longer duration of exposure to football during childhood and adolescence appears to be unrelated to clinical recovery following concussion.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000010672
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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